HomeMy WebLinkAboutDrain Layers Permit 64 Bridle Wood Road r .r. _
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL ��TT
DRAIN LAYER'S PERMIT �Q�To. 5046
19
Pursuant to written application, permission is her by gra 9to he Lic sed Drain Layer
named herein to perform the wor dilate be a (�4
at premises owned by ��p 4 hose address is
and to
- Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (; , INDUSTRIAL
WASTES ( ), OR ( ) Connection w` be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
-
SPECIAL CONDITIONS
Desired Starting Date 71 Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof. Appl nt_has receive ��
Town Permit No. and/or CHD Permit No. a r
Signed
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started 7 Date completed �D--
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspe for Date